Spartacus better treatment options for spondyloarthritis

24 September 2019
Background
About a fifth of Europeans suffers from musculoskeletal disorders. A substantial subgroup are the rheumatic conditions. Within the rheumatic disorders, spondyloarthritis (SpA) is a group of inflammatory diseases that cause joint inflammation, or arthritis. It occurs in about 0.1 – 1% of the population, markedly more in men.
Traditional management of SpA is a step-up strategy where anti-inflammatory drugs and conventional
synthetic disease-modifying anti-rheumatic drugs are administered to fight SpA symptoms. Biologics are
used in second-line refractory patients.

SPARTACUS will address the hypothesis, based on a recent pilot project, that first-line use of biologics in
early peripheral SpA would lead to a better response that could permit temporary use of medicine and even drug-free remission in over half of the patients quickly after diagnosis. In other words, there could be a ‘window of opportunity’ for a more effective SpA treatment with long-lasting effects.

Goals
The project aims to compare effectiveness of inducing clinical remission in early forms of spondyloarthritis
with biologic treatment as compared to standard of care. Furthermore, the project team intents to establish new prognostic biomarkers using cutting edge single-cell technology. Concrete aims are:
- to show the superiority of treatment with biologics compared with a standard step-up approach inpatients with early SpA.
- to delineate the window of opportunity for SpA treatment: <6 months vs. between 6 and 12 months of symptom duration. 
- to explore the rates of drug-free remission by contemporary use of therapy in early SpA.
- to unravel new biomarkers indicating therapy response.

SPARTACUS will also explore the societal and economic impact of this new, temporally restricted biologics
treatment and improved diagnosis.​

Partners
Dirk Elewaut and Martin Guilliams (VIB-UGent Center for Inflammation Research) deliver their expert knowledge on molecular immunology and inflammation, as well as access to the Single Cell Platform.
Rik Lories and Frederik De Smet (KU Leuven Lab of Tissue Homeostasis and Disease) bring their expertise
on epigenetics and CyTOF, while Annelies Boonen (Maastricht UMC, NL) will perform the health economic
evaluation and budget impact analysis. Finally, the Department of Rheumatology at UZGent will be involved, as will the Be-GIANT Consortium (Gent university hospital, Maria Middelares-Gent, ASZ Aalst, AZ Sint-Jan Brugge, AZ Sint-Lucas Brugge, ZNA-Antwerpen, Sint-Augustinus Antwerpen, Leuven university hospital,
Reuma Instituut Hasselt), which was set up to create a unique cohort of newly diagnosed SpA patients (currently 400 patients and counting).

Societal impact
SPARTACUS will determine the health-economic and societal impact of earlier and more biologic intensive
treatment through the use of 2 years’ worth of actual patient data and a model-based lifelong incremental
cost-utility analysis from a healthcare and a societal perspective. The researchers will also work to increase awareness about the value of early recognition and treatment in rheumatology among referring physicians and patientadvocacy groups. These results will be used in direct negotiations with health authorities in Belgium to change current reimbursement criteria for SpA therapy.


Go back to the overview: 'the Grand Challenges Program'​




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